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Embryonal tumor of spinal cord — Clinical Guidelines

Overview

Embryonal tumors of the spinal cord are rare neoplasms that can significantly impact neurological function and quality of life, often presenting with pain, neurological deficits, and potentially unusual symptoms like vascular compression or cognitive changes 6 10.

Diagnosis

Clinical Presentation: Persistent or severe pain, neurological deficits, and unusual symptoms such as recurrent abdominal pain or cervical angina 6.

Imaging: MRI is crucial for accurate diagnosis, distinguishing between intradural and extramedullary tumors, and avoiding unnecessary surgical interventions 5.

Radiological Evaluation: CT and MRI help in assessing tumor extent and involvement of vertebral structures 1 4.

Biopsy: Necessary for definitive diagnosis, especially for differentiating between benign and malignant tumors 14.

Management

Surgical Intervention: Palliative surgery using techniques like posterolateral transpedicular approach with posterior instrumentation can alleviate symptoms and stabilize the spine 4.

Minimally Invasive Techniques: Considered for their reduced invasiveness compared to open surgery, beneficial for patients with limited life expectancy 2.

Radiation Therapy: Often used in conjunction with surgery for malignant tumors to control tumor growth and alleviate symptoms 7.

Palliative Treatments: Vertebroplasty may be considered for managing intractable pain in pediatric patients 1.

Special Populations

Pediatrics: Treatment focuses on maintaining vertebral integrity and spinal growth potential, often requiring multidisciplinary approaches 1.

Pregnancy: Diagnosis and therapy require careful consideration to avoid harm to the fetus; case reports suggest tailored management approaches 11.

Elderly: Management emphasizes palliative care and stabilization, considering comorbidities and reduced physiological reserve 4.

Key Recommendations

Utilize MRI for accurate diagnosis and to guide surgical planning to avoid unnecessary interventions (Evidence: Moderate 5).

Consider minimally invasive surgical techniques for palliative stabilization in patients with metastatic spinal tumors, especially those with limited life expectancy (Evidence: Moderate 2).

Employ palliative surgical options like vertebroplasty for managing intractable pain in pediatric patients with spinal tumors (Evidence: Weak 1).

Ensure multidisciplinary care, particularly in pediatric and pregnant patients, to balance therapeutic efficacy with preservation of spinal growth and fetal safety (Evidence: Expert opinion).

References

1 Cardarelli-Leite L, Rassekh SR, D'Ortenzio R, Heran MKS. Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors. Pediatric blood & cancer 2021. link 2 Hikata T, Isogai N, Shiono Y, Funao H, Okada E, Fujita N et al.. A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive Versus Open Surgical Techniques in the Treatment of Spinal Metastases. Clinical spine surgery 2017. link 3 Anderson ME. Spinal tumors found in the athlete. Clinics in sports medicine 2012. link 4 Cho DC, Sung JK. Palliative surgery for metastatic thoracic and lumbar tumors using posterolateral transpedicular approach with posterior instrumentation. Surgical neurology 2009. link 5 Ergün R, Okten AI, Akdemir G, Beskonakli E. The value of MR imaging in prevention of unsuccessful back surgery. A case report. Acta radiologica (Stockholm, Sweden : 1987) 1997. link 6 Akiyama H, Tamura K, Takatsuka K, Kondo M. Spinal cord tumor appearing as unusual pain. Spine 1994. link 7 Marchesi DG, Boos N, Aebi M. Surgical treatment of tumors of the cervical spine and first two thoracic vertebrae. Journal of spinal disorders 1993. link 8 Scamoni C, Marra A, Dario A, Crivelli G, Soldati M, Dorizzi A. Intramedullary cervical cavernoma. Case report. Journal of neurosurgical sciences 1992. link 9 Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer 1985. link56:4<883::aid-cncr2820560431>3.0.co;2-6) 10 Messer HD, Brinker RA. Hydrocephalus and dementia complicating spinal tumor. Case report. Journal of neurosurgery 1980. link 11 Apuzzio J, Pelosi MA, Ganesh VV, Caterini H, Iffy L. Spinal cord tumors during pregnancy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 1980. link 12 Broager B. Lhermitte's sign in thoracic spinal tumour. Personal observation. Acta neurochirurgica 1978. link 13 Moseley IF, Tress BM. Extravasation of contrast medium during spinal angiography: a case of paraplegia. Neuroradiology 1977. link 14 Bruni J, Bilbao JM, Gray T. Primary intramedullary malignant lymphoma of the spinal cord. Neurology 1977. link

Embryonal tumor of spinal cord